Conference Handouts

Measurement Precision: Supporting Decisions About The Process Of Care, Outcomes and Service Effectiveness

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Session Number: 38 Room: Salon C & D

Presentation Type: symposium

Chair: Ann Doucette Discussant:

Synopsis: Measures are the empirical foundation on which we make decisions about treatment outcomes and the effectiveness of services that children/adolescents receive. We assume their precision, and their adequacy for the samples we study. This symposium takes a critical look at measurement from three perspectives: (1) the sensitivity of the measures to detect longitudinal changes in the sample, (2) the adequacy of the measures to assess clinically meaningful phenomena and to provide useful information for treatment planning, and (3) the relevance of measures in providing feed back on the process and progress of care so that needed modification can be made.

Date:
Tuesday, March 8, 2005

Session Time: 1:15 PM - 2:45 PM

Assessing Outcomes Over Time: Questioning Measurement Precision

Synopsis: This presentation will describe how the Rasch measurement model can be used to examine and increase the precision of measures used to assess change, resulting from intervention, over time. This presentation will illustrate how Rasch item level estimates can be used to determine the sensitivity of a measure in detecting change, as well as the adequacy of a measure in differentiating the sample in terms of change over time. The presentation questions whether the sample characteristics change sufficiently over time (longitudinally) to render initial measures less sensitive to change over time, and illustrates how using Rasch measure scores may improve data longitudinal distributions, effect sizes, and the coefficient of variation.

Communication-Based Measurement in Outcomes Management Applications

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Presenting: John Lyons

All Authors for this paper: John Lyons

Presentation Type: element of symposium

Synopsis: There are significant challenges in assessing outcomes and effectiveness even though more than 1,000 outcome measures have been identified in at least one published outcome study. Most of these measures were developed using psychometric theories (i.e. classical test theory, item response theory). Psychometric strategies rely on mathematical techniques and aim to develop one scale (or multiple scales) that measures single characteristics/attributes. These approaches result in measures that include multiple items and measure a single dimension. This paper addresses a third perspective, clinimetrics. Clinometric approaches rely on judgments (clinicians, patients, etc.) and measure clinical phenomena that comprise unrelated characteristics or attributes. The paper uses the Child and Adolescent Needs and Strengths (CANS) as an illustration.

Synopsis: Traditional assessment measures are often used to diagnose, but rarely used to monitor ongoing progress. Clinicians need formal feedback on client progress. Without formal fine-grained ongoing information on treatment process (therapeutic alliance) and outcomes (symptoms and functioning), clinicians must rely on guesswork. We are now developing new assessment methods that provide frequent feedback about therapeutic process and progress to clinicians and supervisors. This paper describes the early stages of theory and practice of this development at two major sites: a) a private multi-state provider of mental health services to children, and b) a school-based multi-site character education program.